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Program Eligibility Application

Dear Prospective TRiO Student Support Services (SSS) Participant,

By completing and electronically submitting this "Application of Interest", you will be completing the first step of Central Washington University's (CWU) TRiO SSS application process. Please note that, in order to be considered as a potential participant of TRiO SSS, you must be accepted or enrolled at CWU and plan on attending the main campus in Ellensburg, WA.

Also by submitting this application, you are declaring that the information you have submitted is accurate and complete to the best of your knowledge. You are also confirming that you understand that the TRiO SSS staff will be able to access your academic records.

Your application and survey will be placed in a candidate pool to establish our 2017 – 2018 cohort. If you are not notified by July 31, 2017, please contact our office directly at 509.963.2026.

Thank you in advance for your interest in CWU's TRiO Student Support Services Program.

Fields marked with an * are required.

First Name *

Last Name *

Middle Initial

CWU Student ID Number

Contact Phone Number *format: xxx-xxx-xxxx

Email *

Permanent Address *

City *

State *

ZIP *

Campus Address (Current)

City

State

ZIP

Date of Birth *

Month

Day

Year

What is your gender? (optional)

Male

Other

Female

Race/ Ethnicity (optional)

We realize that these categories are not all inclusive of the broad range of Race/Ethnicity options. However, we are bound by federal reporting requirements.

Are you a U.S. Citizen? *

Yes

No

If you are not a US Citizen, are you a permanent resident?

Yes

No

Are you currently enrolled or have you been accepted at CWU? *

Yes

No

You are only eligible for enrollment in TRiO SSS if you are accepted or currently enrolled at Central Washington University.

Which CWU campus are you attending? *

Please note, we are based on the Ellensburg campus.

Do you qualify for CWU Disability Support Services? *

Yes

No

If yes,does CWU's Disability Support Services have the necessary documentation on file?

Yes

No

Have you earned any college credits? *

Yes

No

If yes, how many credits have you earned to date and from which school(s)?

What options are you considering as a major *

Do you have a bachelor's degree? *

Yes

No

Mother's or Guardian's Education Level

If you do not know or if this infomation is unavailable, please use "0"

Mother or Gaurdian Highest grade level completed *

Mother or Gaurdian Years of college completed, if any

Mother or Gaurdian Highest degree earned, if any

Father's or Guardian's Education Level

If you do not know or if this infomation is unavailable, please use "0"

Father or Gaurdian Highest grade level completed *

Father or Gaurdian Years of college completed, if any

Father or Gaurdian Highest degree earned, if any

Have you applied for financial aid at CWU? *

Yes

No

Have you submitted the FAFSA for the coming academic year? *

Yes

No

If you did not apply for financial aid and wish to be considered for TRiO SSS under the low-income eligibility criteria, please call 509-963-2026 regarding the Federal Tax Return Information you need to submit.

Please indicate the areas which you would like assistance

Improving financial literacy *

Yes

No

Academic tutoring *

Yes

No

Adjusting to college *

Yes

No

Advice and assistance in course selection *

Yes

No

Assistance in applying to graduate school *

Yes

No

Information and assistance in applying for Federal Financial Aid and Scholarships *

Yes

No

Other

Have ever participated in any of the following? Check all that apply.

TRiO Student Support Services

TRiO Veterans Upward Bound

TRiO Upward Bound

TRiO Upward Bound Math Science

CAMP

Educational Talent Search

TRiO Educational Opportunity Center

College Success Foundation

US Military

Other (if other, please explain below)

Indicate location(s) dates, and name(s) of the school(s) or program.

How did you hear about CWU's TRiO SSS Program? *

Please tell us why do you think CWU's TRiO SSS Program would be valuable to you? *

How well do you believe your previous education has prepared you for the scholarly requirements of college? *

If you could study/research anywhere in the world for a quarter, where would it be and why? *

List at least three things that you personally value, or feel are important, and why. *

Please tell us about an experience where you recognized a leadership role was needed to address a social or environmental challenge. *

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